ENDODONTICS AND PROSTHODONTICS SPECIALITIES OF DENTISTRY
ENDODONTICS:
Endodontics is a specialty of dentistry, that deals with the tooth pulp and tissues surrounding the root of a tooth. The pulp (containing nerves, arterioles and venules as well as lymphatic tissue and fibrous tissue) can become diseased or injured and thus is unable to repair itself. The pulp then dies and endodontic treatment is required. The word comes from the Greek words endo meaning inside and odons meaning tooth. Literally taken, it means study of that which is "inside the tooth".
Endodontists are dentists who have specialized in this field. Typically they have completed an additional 2-3 years of training following dental school. Many endodontic residents do original research and earn a Master's degree as well as a specialty certificate. They specialize and limit their practice to root canal therapy and root canal surgery, and use their special training and experience in treating difficult cases, such as teeth with narrow or blocked anals, or unusual anatomy. Endodontists may use advanced technology, such as operating microscopes, ultrasonics and digital imaging, to perform these special services, and often have great experience in successfully treating patient who present in pain. Patients requiring root canal therapy are either referred by their general dentists to the endodontist or are self referred. Root canal therapy is also a standard procedure for general dentists.
The most common procedure done in endodontics is root-canal therapy. This procedure aims to save a tooth that would otherwise be extracted (pulled) due to infection caused by decay (a cavity in the tooth), a large filling, periodontal (gum) diseases (perio-endo lesions), or trauma to the tooth. Root canal therapy involves the removal of diseased pulp tissue inside the tooth (the area inside the tooth that becomes infected due to the aforementioned reasons). The aim of treatment is to prevent or eliminate the development of inflammation outside the root (apical periodontitis) by removing the diseased/infected pulp and then sealing the root canal systems with a biocompatible material. When the pulp tissue becomes infected, caused by bacteria from inside the tooth, the infection can leak out of the tooth's root and make the surrounding bone ill and painful or cause an abscess to form. Once the diseased pulp tissues are removed, the body's defense system can then repair the damage created by disease.
Signs to look for include tooth pain, prolonged sensitivity to heat or cold, tenderness to touch and chewing, and discoloration of the tooth. Sometimes, however, there are no symptoms.
When performed by a specialist, most root canals can be performed in one appointment, depending upon the complexity of the case. Endodontists are experts at using local anesthetics to make the procedure virtually pain-free. It is considered a standard of care to use a rubber dam in order to isolate the tooth and provide a clean environment. An opening then is made on the top of the tooth. Then the pulp chamber and root canals are cleaned and shaped for filling and sealing. Often, an intra-pulpal medicament to inhibit bacterial growth is placed and the tooth is filled with a temporary restoration until the second appointment, where the temporary restoration and medicament are removed and the canal(s) are sealed with a root-filling material, usually gutta-percha, thus completing the procedure. Endodontists then refer patients back to their general dentist for placement of a permanent crown or other restoration. After restoration, the tooth continues to function like any other tooth.
Root canal-treated teeth typically last for a lifetime. According to the American Dental Association, root canals save more than 17 million teeth each year. Other treatments, such as extracting the natural tooth and placing an artificial dental implant, often cost 75 to 90 percent more than root canal treatment.
Other procedures practiced in endodontics include incision for drainage and periradicular surgery (apicoectomy). These treatments generally are needed in cases of abscesses, root fractures, and problematic tooth anatomy, but may be indicated in treating teeth that have persistent root end pathosis following root canal treatment.
PROSTHODONTICS:
Prosthodontics is one of the nine dental specialties recognized by the American Dental Association (ADA).
A prosthodontist is a dentist who specializes in prosthodontics, the specialty of implant, esthetic and reconstructive dentistry. Prosthodontists specialize in the restoration of oral function by creating prostheses and restorations (i.e. complete dentures, crowns, implant retained/supported restorations). Cosmetic dentistry, implants and joint problems all fall under the field of prosthodontics.
The American College of Prosthodontists (ACP) [1] ensures standards are maintained in the field. Becoming a prosthodontist requires an additional 3 years of specialty training after obtaining a dental degree (D.D.S. or D.M.D.) in an ADA approved program. An immense amount of time is spent in clinical and didactic study from 3000 hours over 3 years in a British program to 7000 hours over the same period in US accredited programs. Training consists of rigorous preparation in head and neck anatomy, materials science, esthetics, and occlusion (bite). Due to this extensive training, prosthodontists are frequently called upon to treat complex cosmetic cases, full mouth reconstructions, TMJ related disorders, congenital disorders, and sleep apnea by planning and fabricating various prostheses and orthotic appliances.
Maxillofacial prosthetics is a sub-specialty of prosthodontics. Maxillofacial prosthodontists treat patients who have acquired and congenital defects of the head and neck (maxillofacial) region due to surgery, trauma, and/or birth defect. It requires an additional year of training after completing an ADA approved prosthodontic training program. Artificial eyes, ears, and maxillary obturators are commonly planned and fabricated by maxillofacial prosthodontists. Other less commonly employed prostheses include mouth devices used by amputees to aid in daily activities, tracheostomy obturators, and cranial implants.
ORTHODONTICS PROFESSION
Orthodontics is a specialty of dentistry that is concerned with the study and treatment of malocclusions (improper bites), which may be a result of tooth irregularity, disproportionate jaw relationships, or both. The word comes from the Greek words ortho meaning straight and odons meaning tooth.
Orthodontic treatment can focus on dental displacement only, or can deal with the control and modification of facial growth. In the latter case it is better defined as "dentofacial orthopedics". Orthodontic treatment can be carried out for purely aesthetic reasons—improving the general appearance of patients' teeth and face for cosmetic reasons—but treatment is often prescribed for practical reasons, providing the patient with a functionally improved bite (occlusion).
ORTHODONTICS METHODS
If the main goal of the treatment is the dental displacement, most commonly a fixed multibracket therapy is used. In this case orthodontic wires are inserted into dental braces, which can be made from stainless steel or a more esthetic ceramic material.
Also removable appliances, or "plates", headgear, expansion appliances, and many other devices can be used to move teeth. Functional and orthopaedics appliances are used in growing patients (age 5 to 13) with the aim to modify the jaw dimensions and relationship if these are altered. (See Prognathism.) This therapy is frequently followed by a fixed multibracket therapy to align the teeth and refine the occlusion.
After a course of active orthodontic treatment, patients will often wear retainers, which will maintain the teeth in their improved position while the surrounding bone reforms around them. The retainers are generally worn full-time for a short period, perhaps 6 months to a year, and then worn periodically (typically nightly during sleep) for as long as the orthodontist recommends. It is possible for the teeth to stay aligned without regular retainer wear. However, there are many reasons teeth will crowd as a person ages; thus there is no guarantee that teeth, orthodontically treated or otherwise, will stay aligned without retention. For this reason, many orthodontists recommend periodic retainer wear for many years (or indefinitely) after orthodontic treatment.Appropriately trained doctors align the teeth with respect to the surrounding soft tissues, with or without movement of the underlying bones, which can be moved either through growth modification in children or jaw surgery (orthognathic surgery) in adults.
Several appliances are utilized for growth modification; including functional appliances, Headgear and Facemasks.
These "orthopedic appliances" may influence the development of an adolescent's profile and give an improved aesthetic and functional result.
CONDITIONS
The most common condition that the methods of orthodontics are used for is correcting anteroposterior discrepancies. Another common situation leading to orthodontic treatment is crowding of the teeth.
1. Anteroposterior discrepancies:
Anteroposterior discrepancies are deviations between the teeth of the upper and lower jaw in the anteroposterior direction. For instance, the top teeth can be too far forward relative to the lower teeth ("increased overjet".) The headgear is attached to the braces via metal hooks or a facebow and is anchored from the back of the head or neck with straps or a head-cap. Elastic bands are typically then used to apply pressure to the bow or hooks. Its purpose is to slow-down or stop the upper jaw from growing, hence preventing or correcting an overjet. For more details and photographs, see Headgear - Orthodontic.
2. Crowding of teeth:
Another common situation leading to orthodontic treatment is crowding of the teeth. In this situation, there is insufficient room for the normal complement of adult teeth, which can sometimes motivate teeth being extracted in order to make enough room for the remaining teeth
DIAGNOSIS/TREATMENT PLANNING:In diagnosis and treatment planning, the orthodontist must (1) recognize the various characteristics of malocclusion and dentofacial deformity; (2) define the nature of the problem, including the etiology if possible; and (3) design a treatment strategy based on the specific needs and desires of the individual. (4) present the treatment strategy to the patient in such a way that the patient fully understands the ramifications of his/her decision.
OTHORDONTIC EDUCATION:
Various countries have their own systems for training and registering specialist orthodontists; generally a period of full-time post-graduate study is required for a dentist to qualify as an orthodontist. The orthodontic specialty is the earliest dental specialty.
EU - COUNTRIES:
In the United Kingdom, this training period lasts three years, after completion of a membership from a Royal College. A further two years is then completed to train to consultant level, after which a fellowship examination from the Royal College is sat. In other parts of Europe, a similar pattern is followed. It is always worth contacting the professional body responsible for registering orthodontists to ensure that the orthodontist you wish to consult is a recognized specialist.
UNITED STATES
A number of medical and dental schools in the United States offer advanced education in the specialty of Orthodontics to dentists seeking postgraduate education. The courses range from two to three years of full-time classes and clinical work in the clinical and theoretical aspects of orthodontics. Generally, admission is based on an application process followed by an extensive interviewing process by the institution, in order to select the best candidate. Candidates usually have to contact the individual school directly for the application process. A list of orthodontic schools can be obtained from the American Association of Orthodontists[1].
In addition to American Dental Association recognized specialty programs, there are other non-specialty continuing education programs. Two of the most prominent are the International Association for Orthodontics [2] and the United States Dental Institute [3]. These organizations provide very advanced continuing education to both general dentists and pedodontists (child specialists). These programs are taught by orthodontists, pedodontists, and experienced general dentists enabling your family dentist or pedodontist to provide quality orthodontic care. Some of these more experienced dentists can provide care for even the most complex of cases while others may choose to treat only simple cases and refer more complex treatment to orthodontists.
Orthodontic treatment can focus on dental displacement only, or can deal with the control and modification of facial growth. In the latter case it is better defined as "dentofacial orthopedics". Orthodontic treatment can be carried out for purely aesthetic reasons—improving the general appearance of patients' teeth and face for cosmetic reasons—but treatment is often prescribed for practical reasons, providing the patient with a functionally improved bite (occlusion).
ORTHODONTICS METHODS
If the main goal of the treatment is the dental displacement, most commonly a fixed multibracket therapy is used. In this case orthodontic wires are inserted into dental braces, which can be made from stainless steel or a more esthetic ceramic material.
Also removable appliances, or "plates", headgear, expansion appliances, and many other devices can be used to move teeth. Functional and orthopaedics appliances are used in growing patients (age 5 to 13) with the aim to modify the jaw dimensions and relationship if these are altered. (See Prognathism.) This therapy is frequently followed by a fixed multibracket therapy to align the teeth and refine the occlusion.
After a course of active orthodontic treatment, patients will often wear retainers, which will maintain the teeth in their improved position while the surrounding bone reforms around them. The retainers are generally worn full-time for a short period, perhaps 6 months to a year, and then worn periodically (typically nightly during sleep) for as long as the orthodontist recommends. It is possible for the teeth to stay aligned without regular retainer wear. However, there are many reasons teeth will crowd as a person ages; thus there is no guarantee that teeth, orthodontically treated or otherwise, will stay aligned without retention. For this reason, many orthodontists recommend periodic retainer wear for many years (or indefinitely) after orthodontic treatment.Appropriately trained doctors align the teeth with respect to the surrounding soft tissues, with or without movement of the underlying bones, which can be moved either through growth modification in children or jaw surgery (orthognathic surgery) in adults.
Several appliances are utilized for growth modification; including functional appliances, Headgear and Facemasks.
These "orthopedic appliances" may influence the development of an adolescent's profile and give an improved aesthetic and functional result.
CONDITIONS
The most common condition that the methods of orthodontics are used for is correcting anteroposterior discrepancies. Another common situation leading to orthodontic treatment is crowding of the teeth.
1. Anteroposterior discrepancies:
Anteroposterior discrepancies are deviations between the teeth of the upper and lower jaw in the anteroposterior direction. For instance, the top teeth can be too far forward relative to the lower teeth ("increased overjet".) The headgear is attached to the braces via metal hooks or a facebow and is anchored from the back of the head or neck with straps or a head-cap. Elastic bands are typically then used to apply pressure to the bow or hooks. Its purpose is to slow-down or stop the upper jaw from growing, hence preventing or correcting an overjet. For more details and photographs, see Headgear - Orthodontic.
2. Crowding of teeth:
Another common situation leading to orthodontic treatment is crowding of the teeth. In this situation, there is insufficient room for the normal complement of adult teeth, which can sometimes motivate teeth being extracted in order to make enough room for the remaining teeth
DIAGNOSIS/TREATMENT PLANNING:In diagnosis and treatment planning, the orthodontist must (1) recognize the various characteristics of malocclusion and dentofacial deformity; (2) define the nature of the problem, including the etiology if possible; and (3) design a treatment strategy based on the specific needs and desires of the individual. (4) present the treatment strategy to the patient in such a way that the patient fully understands the ramifications of his/her decision.
OTHORDONTIC EDUCATION:
Various countries have their own systems for training and registering specialist orthodontists; generally a period of full-time post-graduate study is required for a dentist to qualify as an orthodontist. The orthodontic specialty is the earliest dental specialty.
EU - COUNTRIES:
In the United Kingdom, this training period lasts three years, after completion of a membership from a Royal College. A further two years is then completed to train to consultant level, after which a fellowship examination from the Royal College is sat. In other parts of Europe, a similar pattern is followed. It is always worth contacting the professional body responsible for registering orthodontists to ensure that the orthodontist you wish to consult is a recognized specialist.
UNITED STATES
A number of medical and dental schools in the United States offer advanced education in the specialty of Orthodontics to dentists seeking postgraduate education. The courses range from two to three years of full-time classes and clinical work in the clinical and theoretical aspects of orthodontics. Generally, admission is based on an application process followed by an extensive interviewing process by the institution, in order to select the best candidate. Candidates usually have to contact the individual school directly for the application process. A list of orthodontic schools can be obtained from the American Association of Orthodontists[1].
In addition to American Dental Association recognized specialty programs, there are other non-specialty continuing education programs. Two of the most prominent are the International Association for Orthodontics [2] and the United States Dental Institute [3]. These organizations provide very advanced continuing education to both general dentists and pedodontists (child specialists). These programs are taught by orthodontists, pedodontists, and experienced general dentists enabling your family dentist or pedodontist to provide quality orthodontic care. Some of these more experienced dentists can provide care for even the most complex of cases while others may choose to treat only simple cases and refer more complex treatment to orthodontists.
PUBLIC HEALTH INFORMATION SYSTEM [INFORMATICS] IN THE UNITED STATES
PUBLIC HEALTH INFORMATICS IN THE UNITED STATES
Public Health Informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning.
It is one of the subdomains of (bio)medical or health informatics.
In the same way that Public Health as a distinct field relates to healthcare generally, public health informatics is distinguished from healthcare informatics by emphasizing data about populations rather than that of individuals. The activities of public health informatics can be broadly divided into the collection, storage, and analysis of data of interest to the various activities of public health.
In the United States, public health informatics is practiced by individuals in public health agencies at the federal and state levels and in the larger local health jurisdictions. Additionally, research and training in public health informatics takes place at a variety of academic institutions.
At the federal Centers for Disease Control and Prevention in Atlanta, Georgia, the National Center for Public Health Informatics (NCPHI) is charged with providing national leadership in public health informatics. The major initiative in this area at the beginning of the 21st century has been to promote and fund the definition, coordination, and implementation of the Public Health Information Network (PHIN).
The bulk of the work of public health informatics in the United States, as with public health generally, takes place at the state and local level, in the state departments of health and the county or parish departments of health. At a state health department the activities may include: collection and storage of vital statistics (birth and death records); collection of reports of communicable disease cases from doctors, hospitals, and laboratories, used for infectious disease surveillance; display of infectious disease statistics and trends; collection of child immunization and lead screening information; daily collection and analysis of emergency room data to detect early evidence of biological threats; collection of hospital capacity information to allow for planning of responses in case of emergencies. Each of these activities presents its own information processing challenge.
COLLECTION OF PUBLIC HEALTH DATA
Before the advent of the internet, public health data in the United States, like healthcare data and other business data, were collected on paper forms and stored centrally at the relevant public health agency. If the data were to be computerized they required a distinct data entry process, were stored in the various file formats of the day and analyzed by mainframe computers using standard batch processing.
(TODO: describe CDC-provided DOS/desktop-based systems like TIMSS (TB), STDMIS (Sexually transmitted diseases); Epi-Info for epidemiology investigations; and others )
Since the beginning of the worldwide web, public health agencies with sufficient information technology resources have been transitioning to web-based collection of public health data, and, more recently, to automated messaging of the same information. In the years roughly 2000 to 2005 the Centers for Disease Control and Prevention, under its National Electronic Disease Surveillance System (NEDSS), built and provided free to states a comprehensive web and message-based reporting system called the NEDSS Base System (NBS). Many states and even larger counties have built their own versions of electronic disease surveillance systems, such as Pennsylvania's PA-NEDSS.
To promote interoperability, the CDC has encouraged the adoption in public health data exchange of several standard vocabularies and messaging formats from the health care world. The most prominent of these are: the Health Level 7 (HL7) standards for health care messaging; the LOINC system for encoding laboratory test and result information; and the Systematized Nomenclature of Medicine (SNOMED) vocabulary of health care concepts.
Since about 2005, the CDC has promoted the idea of the Public Health Information Network to facilitate the transmission of data from various partners in the health care industry and elsewhere (hospitals, clinical and environmental laboratories, doctors' practices, pharmacies) to local health agencies, then to state health agencies, and then to the CDC. At each stage the entity must be capable of receiving the data, storing it, aggregating it appropriately, and transmitting it to the next level. A typical example would be infectious disease data, which hospitals, labs, and doctors are legally required to report to local health agencies; local health agencies must report to their state public health department; and which the states must report in aggregate form to the CDC. Among other uses, the CDC publishes the Morbidity and Mortality Weekly Report (MMWR) based on these data acquired systematically from across the United States. (TODO: include the next step: CDC reports to the World Health Organization? I am not familiar.)
Major issues in the collection of public health data are: awareness of the need to report data; lack of resources of either the reporter or collector; lack of interoperability of data interchange formats, which can be at the purely syntactic or at the semantic level; variation in reporting requirements across the states, territories, and localities.
STORAGE OF PUBLIC DATA
Storage of public health data shares the same data management issues as other industries. And like other industries, the details of how these issues play out are affected by the nature of the data being managed.
Due to the complexity and variability of public health data, like health care data generally, the issue of data modeling presents a particular challenge. While a generation ago flat data sets for statistical analysis were the norm, today's requirements of interoperability and integrated sets of data across the public health enterprise require more sophistication. The relational database is increasingly the norm in public health informatics. Designers and implementers of the many sets of data required for various public health purposes must find a workable balance between very complex and abstract data models such as HL7's Reference Information Model (RIM) or CDC's Public Health Logical Data Model, and simplistic, ad hoc models that untrained public health practitioners come up with and feel capable of working with.
Due to the variability of the incoming data to public health jurisdictions, data quality assurance is also a major issue.
ANALYSIS OF PUBLIC HEALTH DATA
The need to extract usable public health information from the mass of data available requires the public health informaticist to become familiar with a range of analysis tools, ranging from business intelligence tools to produce routine or ad hoc reports, to sophisticated statistical analysis tools such as SAS and SPSS, to Graphical Information Systems (GIS) to expose the geographical dimension of public health trends.
Public Health Informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning.
It is one of the subdomains of (bio)medical or health informatics.
In the same way that Public Health as a distinct field relates to healthcare generally, public health informatics is distinguished from healthcare informatics by emphasizing data about populations rather than that of individuals. The activities of public health informatics can be broadly divided into the collection, storage, and analysis of data of interest to the various activities of public health.
In the United States, public health informatics is practiced by individuals in public health agencies at the federal and state levels and in the larger local health jurisdictions. Additionally, research and training in public health informatics takes place at a variety of academic institutions.
At the federal Centers for Disease Control and Prevention in Atlanta, Georgia, the National Center for Public Health Informatics (NCPHI) is charged with providing national leadership in public health informatics. The major initiative in this area at the beginning of the 21st century has been to promote and fund the definition, coordination, and implementation of the Public Health Information Network (PHIN).
The bulk of the work of public health informatics in the United States, as with public health generally, takes place at the state and local level, in the state departments of health and the county or parish departments of health. At a state health department the activities may include: collection and storage of vital statistics (birth and death records); collection of reports of communicable disease cases from doctors, hospitals, and laboratories, used for infectious disease surveillance; display of infectious disease statistics and trends; collection of child immunization and lead screening information; daily collection and analysis of emergency room data to detect early evidence of biological threats; collection of hospital capacity information to allow for planning of responses in case of emergencies. Each of these activities presents its own information processing challenge.
COLLECTION OF PUBLIC HEALTH DATA
Before the advent of the internet, public health data in the United States, like healthcare data and other business data, were collected on paper forms and stored centrally at the relevant public health agency. If the data were to be computerized they required a distinct data entry process, were stored in the various file formats of the day and analyzed by mainframe computers using standard batch processing.
(TODO: describe CDC-provided DOS/desktop-based systems like TIMSS (TB), STDMIS (Sexually transmitted diseases); Epi-Info for epidemiology investigations; and others )
Since the beginning of the worldwide web, public health agencies with sufficient information technology resources have been transitioning to web-based collection of public health data, and, more recently, to automated messaging of the same information. In the years roughly 2000 to 2005 the Centers for Disease Control and Prevention, under its National Electronic Disease Surveillance System (NEDSS), built and provided free to states a comprehensive web and message-based reporting system called the NEDSS Base System (NBS). Many states and even larger counties have built their own versions of electronic disease surveillance systems, such as Pennsylvania's PA-NEDSS.
To promote interoperability, the CDC has encouraged the adoption in public health data exchange of several standard vocabularies and messaging formats from the health care world. The most prominent of these are: the Health Level 7 (HL7) standards for health care messaging; the LOINC system for encoding laboratory test and result information; and the Systematized Nomenclature of Medicine (SNOMED) vocabulary of health care concepts.
Since about 2005, the CDC has promoted the idea of the Public Health Information Network to facilitate the transmission of data from various partners in the health care industry and elsewhere (hospitals, clinical and environmental laboratories, doctors' practices, pharmacies) to local health agencies, then to state health agencies, and then to the CDC. At each stage the entity must be capable of receiving the data, storing it, aggregating it appropriately, and transmitting it to the next level. A typical example would be infectious disease data, which hospitals, labs, and doctors are legally required to report to local health agencies; local health agencies must report to their state public health department; and which the states must report in aggregate form to the CDC. Among other uses, the CDC publishes the Morbidity and Mortality Weekly Report (MMWR) based on these data acquired systematically from across the United States. (TODO: include the next step: CDC reports to the World Health Organization? I am not familiar.)
Major issues in the collection of public health data are: awareness of the need to report data; lack of resources of either the reporter or collector; lack of interoperability of data interchange formats, which can be at the purely syntactic or at the semantic level; variation in reporting requirements across the states, territories, and localities.
STORAGE OF PUBLIC DATA
Storage of public health data shares the same data management issues as other industries. And like other industries, the details of how these issues play out are affected by the nature of the data being managed.
Due to the complexity and variability of public health data, like health care data generally, the issue of data modeling presents a particular challenge. While a generation ago flat data sets for statistical analysis were the norm, today's requirements of interoperability and integrated sets of data across the public health enterprise require more sophistication. The relational database is increasingly the norm in public health informatics. Designers and implementers of the many sets of data required for various public health purposes must find a workable balance between very complex and abstract data models such as HL7's Reference Information Model (RIM) or CDC's Public Health Logical Data Model, and simplistic, ad hoc models that untrained public health practitioners come up with and feel capable of working with.
Due to the variability of the incoming data to public health jurisdictions, data quality assurance is also a major issue.
ANALYSIS OF PUBLIC HEALTH DATA
The need to extract usable public health information from the mass of data available requires the public health informaticist to become familiar with a range of analysis tools, ranging from business intelligence tools to produce routine or ad hoc reports, to sophisticated statistical analysis tools such as SAS and SPSS, to Graphical Information Systems (GIS) to expose the geographical dimension of public health trends.
BRANCHES OF HEALTH INFORMATICS
BRANCHES OF HEALTH INFORMATICS are as follows:
1. CLINICAL INFORMATICS:
Clinical Informatics is a sub-field of medical informatics. It focuses on computer applications that address medical data (collection, analysis, representation). Clinical informatics is a combination of information science, computer science, and clinical science designed to assist in the management and processing of data, information and knowledge to support the practice and delivery of clinical care (Shortliffe and Perreault, Medical Informatics: Computing applications in health care and biomedicine).
The field of Clinical informatics covers the following activities:
Medical Data Mining Electronic Medical Record (EMR's) Decision Support Systems Hospital Information System
2. NURSING INFORMATICS
Nursing Informatics is a specialty of Health care informatics which deals with the support of nursing by information systems in delivery, documentation, administration and evaluation of patient care and prevention of diseases.Various definitions of Nursing Informatics have been proposed; perhaps the most widely currently accepted definition comes from the International Medical Informatics Association - Nursing Informatics Special Interest Group adopted August 1998, Seoul, Korea: Nursing informatics is the integration of nursing, its information, and information management with information processing and communication technology, to support the health of people world wide.[1]
A more recent definition of Nursing Informatics comes from the American Nurses Association's Scope and Standards for Nursing Informatics Practice (2006): Nursing Informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice.
An early (and still valid) definition was proposed by Hannah (1985): The use of information technologies in relation to any of the functions that are within the purview of nursing and are carried out by nurses in the performance of their duties. This comprises the care of patients, administration, education and research.
Other definitions also exist. For example, William Goossen, from The Netherlands, developed a longer definition:
Goossen WTF (1996). Nursing information management and processing: a framework and definition for systems analysis, design and evaluation. International Journal of Biomedical Computing, 40, 187-195.
"Nursing informatics is the multidisciplinary scientific endeavor of analyzing, formalizing and modeling how nurses collect and manage data, process data into information and knowledge, make knowledge-based decisions and inferences for patient care, and use this empirical and experiential knowledge in order to broaden the scope and enhance the quality of their professional practice. The scientific methods central to nursing informatics are focused on:
Using a discourse about motives for computerized systems, Analyzing, formalizing and modeling nursing information processing and nursing knowledge for all components of nursing practice: clinical practice, management, education and research, Investigating determinants, conditions, elements, models and processes in order to design, and implement as well as test the effectiveness and efficiency of computerized information, (tele)communication and network systems for nursing practice, and Studying the effects of these systems on nursing practice."
3. CONSUMER-HEALTH INFORMATICS
Consumer health informatics is a relatively new discipline and has been defined by Gunther Eysenbach as follows:
Consumer health informatics is the branch of medical informatics that analyses consumers’ needs for information; studies and implements methods of making information accessible to consumers; and models and integrates consumers’ preferences into medical information systems. (Eysenbach 2000)
Consumer health informatics (CHI) provides patients and healthy consumers with the e-health tools, skills and support they need to better manage their health decisions. Examples for CHI tools are Web sites providing self-care information, Internet-based disease management tools, telemedicine, personal health records (PHRs), online support groups, etc. In the age of the Internet, almost any health information system or communication tool has an interface for consumers.
Healthcare providers are turning to consumer health informatics to provide patients not only with health advice but with an opportunity to manage certain aspects of their condition. One of the purposes of the aforementionned PHR is to involve patients in the management of their healthcare. Meanwhile, consumers are themselves looking for resources on the Internet or even starting their own.
4. PUBLIC HEALTH INFORMATICS
Public Health Informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning.
It is one of the subdomains of (bio)medical or health informatics.
In the same way that Public Health as a distinct field relates to healthcare generally, public health informatics is distinguished from healthcare informatics by emphasizing data about populations rather than that of individuals. The activities of public health informatics can be broadly divided into the collection, storage, and analysis of data of interest to the various activities of public health
5.DENTAL INFORMATICS
Dental informatics is the application of computer and information science to improve dental practice, research, education and management. During the last forty years it has developed into a research discipline of significant scale and scope. It can be considered a subset of medical informatics and biomedical informatics.
It is the understanding, skills and tools that enable the sharing and use of information to promote oral health and improve dental practice, research, education and management. It encompasses electronic health records, CAD/CAM technology, diagnostic digital imaging and administrative information for all dentistry disciplines.
6. CLINICAL RESEARCH INFORMATICS
Clinical Research Informatics (CRI) is the sub-domain of Biomedical informatics or Medical Informatics concerned with the application of informatics theory and methods to design, conduct and improve clinical research and disseminate the knowledge gained. It overlaps considerably with the related rapidly developing domain of Translational Research Informatics.
Clinical research is defined by the National Institutes of Health [1] as being comprised of studies and trials in human subjects that fall into the three sub-categories:
(1) Patient-oriented research. Research conducted with human subjects (or on material of human origin such as tissues, specimens and cognitive phenomena) for which an investigator (or colleague) directly interacts with human subjects. Patient-oriented researchincludes: (a) mechanisms of human disease, (b) therapeutic interventions, (c) clinical trials, or (d) development of new technologies.(2) Epidemiologic and behavioral studies.(3) Outcomes research and health services research.
7. BIOINFORMATICS
Bioinformatics and computational biology involve the use of techniques including applied mathematics, informatics, statistics, computer science, artificial intelligence, chemistry, and biochemistry to solve biological problems usually on the molecular level. Research in computational biology often overlaps with systems biology. Major research efforts in the field include sequence alignment, gene finding, genome assembly, protein structure alignment, protein structure prediction, prediction of gene expression and protein-protein interactions, and the modeling of evolution.
8. VETERINARY INFORMATICS
Veterinary informatics applies information technology to healthcare. Veterinary informatics and the larger field of medical informatics is often called health care informatics or biomedical informatics, and forms part of the wider domain of eHealth. These later-generation terms reflect the substantive contribution of the citizen & non-medical professions to the generation and usage of healthcare data and related information. Additionally, medical informaticians are active in bioinformatics and other fields not strictly defined as health care.These include:
I. architectures for electronic medical records and other health information systems used for billing, scheduling or research. II. decision support systems in healthcare III. messaging standards for the exchange of information between health care information systems (e.g. through the use of the HL7 data exchange standard) - these specifically define the means to exchange data, not the content IV. controlled medical vocabularies such as the Standardized Nomenclature of Medicine, Clinical Terms (SNOMED-CT) or Logical Observation Identifiers Names and Codes (LOINC) - used to allow a standard, accurate exchange of data content between systems and providers. V. use of hand-held or portable devices to assist providers with data entry/retrieval or medical decision-makingHISTORY: Medical informatics began in the 1950s with the rise of usable computation devices, computers.
Early names for medical informatics included medical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data processing, medical information processing, medical information science, medical software engineering and medical computer technology.
The earliest use of computation for veterinary medicine was ...
9. PHARMACY INFORMATICS
Pharmacy informatics (PIX), also referred to as pharmacoinformatics, is the application of computers to the storage, retrieval and analysis of drug information. PIX systems help the pharmacist manage information including but not limited to medical insurance records of patients, drug interaction data, as well as prescription data.
Pharmacy informatics is the study of interactions between natural and engineered systems within health care with a focus on pharmaceutical care and improved patient safety.
10. IMAGING INFORMATICS is also a branch.
1. CLINICAL INFORMATICS:
Clinical Informatics is a sub-field of medical informatics. It focuses on computer applications that address medical data (collection, analysis, representation). Clinical informatics is a combination of information science, computer science, and clinical science designed to assist in the management and processing of data, information and knowledge to support the practice and delivery of clinical care (Shortliffe and Perreault, Medical Informatics: Computing applications in health care and biomedicine).
The field of Clinical informatics covers the following activities:
Medical Data Mining Electronic Medical Record (EMR's) Decision Support Systems Hospital Information System
2. NURSING INFORMATICS
Nursing Informatics is a specialty of Health care informatics which deals with the support of nursing by information systems in delivery, documentation, administration and evaluation of patient care and prevention of diseases.Various definitions of Nursing Informatics have been proposed; perhaps the most widely currently accepted definition comes from the International Medical Informatics Association - Nursing Informatics Special Interest Group adopted August 1998, Seoul, Korea: Nursing informatics is the integration of nursing, its information, and information management with information processing and communication technology, to support the health of people world wide.[1]
A more recent definition of Nursing Informatics comes from the American Nurses Association's Scope and Standards for Nursing Informatics Practice (2006): Nursing Informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice.
An early (and still valid) definition was proposed by Hannah (1985): The use of information technologies in relation to any of the functions that are within the purview of nursing and are carried out by nurses in the performance of their duties. This comprises the care of patients, administration, education and research.
Other definitions also exist. For example, William Goossen, from The Netherlands, developed a longer definition:
Goossen WTF (1996). Nursing information management and processing: a framework and definition for systems analysis, design and evaluation. International Journal of Biomedical Computing, 40, 187-195.
"Nursing informatics is the multidisciplinary scientific endeavor of analyzing, formalizing and modeling how nurses collect and manage data, process data into information and knowledge, make knowledge-based decisions and inferences for patient care, and use this empirical and experiential knowledge in order to broaden the scope and enhance the quality of their professional practice. The scientific methods central to nursing informatics are focused on:
Using a discourse about motives for computerized systems, Analyzing, formalizing and modeling nursing information processing and nursing knowledge for all components of nursing practice: clinical practice, management, education and research, Investigating determinants, conditions, elements, models and processes in order to design, and implement as well as test the effectiveness and efficiency of computerized information, (tele)communication and network systems for nursing practice, and Studying the effects of these systems on nursing practice."
3. CONSUMER-HEALTH INFORMATICS
Consumer health informatics is a relatively new discipline and has been defined by Gunther Eysenbach as follows:
Consumer health informatics is the branch of medical informatics that analyses consumers’ needs for information; studies and implements methods of making information accessible to consumers; and models and integrates consumers’ preferences into medical information systems. (Eysenbach 2000)
Consumer health informatics (CHI) provides patients and healthy consumers with the e-health tools, skills and support they need to better manage their health decisions. Examples for CHI tools are Web sites providing self-care information, Internet-based disease management tools, telemedicine, personal health records (PHRs), online support groups, etc. In the age of the Internet, almost any health information system or communication tool has an interface for consumers.
Healthcare providers are turning to consumer health informatics to provide patients not only with health advice but with an opportunity to manage certain aspects of their condition. One of the purposes of the aforementionned PHR is to involve patients in the management of their healthcare. Meanwhile, consumers are themselves looking for resources on the Internet or even starting their own.
4. PUBLIC HEALTH INFORMATICS
Public Health Informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning.
It is one of the subdomains of (bio)medical or health informatics.
In the same way that Public Health as a distinct field relates to healthcare generally, public health informatics is distinguished from healthcare informatics by emphasizing data about populations rather than that of individuals. The activities of public health informatics can be broadly divided into the collection, storage, and analysis of data of interest to the various activities of public health
5.DENTAL INFORMATICS
Dental informatics is the application of computer and information science to improve dental practice, research, education and management. During the last forty years it has developed into a research discipline of significant scale and scope. It can be considered a subset of medical informatics and biomedical informatics.
It is the understanding, skills and tools that enable the sharing and use of information to promote oral health and improve dental practice, research, education and management. It encompasses electronic health records, CAD/CAM technology, diagnostic digital imaging and administrative information for all dentistry disciplines.
6. CLINICAL RESEARCH INFORMATICS
Clinical Research Informatics (CRI) is the sub-domain of Biomedical informatics or Medical Informatics concerned with the application of informatics theory and methods to design, conduct and improve clinical research and disseminate the knowledge gained. It overlaps considerably with the related rapidly developing domain of Translational Research Informatics.
Clinical research is defined by the National Institutes of Health [1] as being comprised of studies and trials in human subjects that fall into the three sub-categories:
(1) Patient-oriented research. Research conducted with human subjects (or on material of human origin such as tissues, specimens and cognitive phenomena) for which an investigator (or colleague) directly interacts with human subjects. Patient-oriented researchincludes: (a) mechanisms of human disease, (b) therapeutic interventions, (c) clinical trials, or (d) development of new technologies.(2) Epidemiologic and behavioral studies.(3) Outcomes research and health services research.
7. BIOINFORMATICS
Bioinformatics and computational biology involve the use of techniques including applied mathematics, informatics, statistics, computer science, artificial intelligence, chemistry, and biochemistry to solve biological problems usually on the molecular level. Research in computational biology often overlaps with systems biology. Major research efforts in the field include sequence alignment, gene finding, genome assembly, protein structure alignment, protein structure prediction, prediction of gene expression and protein-protein interactions, and the modeling of evolution.
8. VETERINARY INFORMATICS
Veterinary informatics applies information technology to healthcare. Veterinary informatics and the larger field of medical informatics is often called health care informatics or biomedical informatics, and forms part of the wider domain of eHealth. These later-generation terms reflect the substantive contribution of the citizen & non-medical professions to the generation and usage of healthcare data and related information. Additionally, medical informaticians are active in bioinformatics and other fields not strictly defined as health care.These include:
I. architectures for electronic medical records and other health information systems used for billing, scheduling or research. II. decision support systems in healthcare III. messaging standards for the exchange of information between health care information systems (e.g. through the use of the HL7 data exchange standard) - these specifically define the means to exchange data, not the content IV. controlled medical vocabularies such as the Standardized Nomenclature of Medicine, Clinical Terms (SNOMED-CT) or Logical Observation Identifiers Names and Codes (LOINC) - used to allow a standard, accurate exchange of data content between systems and providers. V. use of hand-held or portable devices to assist providers with data entry/retrieval or medical decision-makingHISTORY: Medical informatics began in the 1950s with the rise of usable computation devices, computers.
Early names for medical informatics included medical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data processing, medical information processing, medical information science, medical software engineering and medical computer technology.
The earliest use of computation for veterinary medicine was ...
9. PHARMACY INFORMATICS
Pharmacy informatics (PIX), also referred to as pharmacoinformatics, is the application of computers to the storage, retrieval and analysis of drug information. PIX systems help the pharmacist manage information including but not limited to medical insurance records of patients, drug interaction data, as well as prescription data.
Pharmacy informatics is the study of interactions between natural and engineered systems within health care with a focus on pharmaceutical care and improved patient safety.
10. IMAGING INFORMATICS is also a branch.
MEDICAL INORMATICS
Health informatics or medical informatics is the intersection of information science, computer science and health care. It deals with the resources, devices and methods required to optimize the acquisition, storage, retrieval and use of information in health and biomedicine. Health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems.
Subdomains of (bio)medical or health care informatics include: clinical informatics, nursing informatics, imaging informatics, consumer health informatics, public health informatics, dental informatics, clinical research informatics, bioinformatics, veterinary informatics, and pharmacy informatics.
A list of Health Informatics Publications is being developed at Health Informatics Publications.
ASPECTS OF MEDICAL INFORMATICS1. architectures for electronic medical records and other health information systems used for billing, scheduling or research 2. decision support systems in healthcare, including clinical decision support systems 3. standards (e.g. DICOM, HL7) and integration profiles (e.g. Integrating the Healthcare Enterprise) to facilitate the exchange of information between healthcare information systems - these specifically define the means to exchange data, not the content 4. controlled medical vocabularies (CMVs) such as the Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT), Logical Observation Identifiers Names and Codes (LOINC), OpenGALEN Common Reference Model or the highly complex UMLS - used to allow a standard, accurate exchange of data content between systems and providers 4. use of hand-held or portable devices to assist providers with data entry/retrieval or medical decision-making
HISTORYThere is a patent pending for a Medical Informatics Public Utility which would serve as the "common platform" of communication for all existing provincial software products as well as the safe repository for the public's medical records. The potential for the reduction of medical errors, fraud and reduction of duplication is staggering. The number of lives saved could exceed a minimum of 100,000 per year according to the Institute of Medicine's current medical error mortality statistics.
Medical informatics began to take off in the US in the 1950s with the rise of the microchip and computers.
Early names for medical informatics included medical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data processing, medical information processing, medical information science, medical software engineering and medical computer technology.
Since the 1970s the coordinating body has been the International Medical Informatics Association (IMIA)
MEDICAL HEALTH INFORMATICS LAW
Health informatics law deals with evolving and sometimes complex legal principles as they apply to information technology in health-related fields. It addresses the privacy, ethical and operational issues that invariably arise when electronic tools, information and media are used in health care delivery. Health Informatics Law also applies to all matters that involve information technology, health care and the interaction of information. It deals with the circumstances under which data and records are shared with other fields or areas that support and enhance patient care.
UTILITY OF MEDICAL INFORMATICS
Both political parties continue to squabble without solutions about the escalating costs of health care as benefits erode and more and more working Americans lose coverage. The problem with controlling health care costs is that the health care system itself is out of control because it lacks controls. Health information management is in a chaotic state of affairs as it is a collage of paper records, and medical practice software which do not record clinical encounters. Instead they capture charges. And electronic medical records software companies are incapable of communicating across their provincial software platforms. The solution to this grave problem is actually rather simple.
Public utilities have historically been established to protect the health, safety, and welfare of the public at large. Public utilities are funded by bond issues, deliver a return on investment, and are subject to public review and oversight. A Medical Informatics Public Utility, which would serve as the repository for the real time medical records of the public, would offer a quality and efficiency of care that can potentially free up 25% of the health care spending in the United States alone to meet the growing needs of the aging population. Many studies have concluded that a centralized repository of information can achieve these goals but have not offered a solution.
A Medical Informatics Public Utility would serve as the "common platform" of communication for all existing provincial software products as well as the safe repository for the public's medical records. The potential for the reduction of medical errors, fraud and reduction of duplication is staggering. The number of lives saved could exceed a minimum of 100,000 per year according to the Institute of Medicine's current medical error mortality statistics.
Most importantly, a Medical Informatics Public Utility would serve as a tremendous economic engine in that: the real time database developed would create a platform to get new treatments to market more quickly and more effectively evaluated, spot epidemiological events faster, induce software developers to develop products for the new total repository environment, free up funds to utilize more hands on care, allow for patient centered care and patient control of their health care, and allow physician to physician access of the patient's complete medical record.
UNITED STATES' MEDICAL INFORMATICSThe earliest use of computation for medicine was for dental projects in the 1950s at the United States National Bureau of Standards by Robert Ledley.
The next step in the mid 1950s were the development of expert systems such as MYCIN and INTERNIST-I. In 1965, the National Library of Medicine started to use MEDLINE and MEDLARS. At this time, Neil Pappalardo, Curtis Marble, and Robert Greenes developed MUMPS (Massachusetts General Hospital Utility Multi-Programming System) in Octo Barnett's Laboratory of Computer Science at Massachusetts General Hospital in Boston. In the 1970s and 1980s it was the most commonly used programming language for clinical applications. The MUMPS operating system was used to support MUMPS language specifications. As of 2004, a descendent of this system is being used in the United States Veterans Affairs hospital system.The VA has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture or VistA. A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 healthcare facilities.
In the 1970's a growing number of commercial vendors began to market practice management and electronic medical records systems. Although a profusion of products exists, currently only a minority of health practitioners use fully featured electronic healthcare records systems.
In the United States in 1996, HIPAA regulations concerning privacy and medical record transmission created the impetus for large numbers of physicians to move towards using EMR software, primarily for the purpose of secure medical billing.
In the US, progress towards a standardized health information infrastructure is underway. In 2004, the US Department of Health and Human Services (HHS) formed the Office of the National Coordinator for Health Information Technology (ONCHIT) [1], headed by David J. Brailer, M.D., Ph.D. The mission of this office is to achieve widespread adoption of interoperable electronic health records (EHRs) in the US within 10 years. For more information regarding federal initiatives in this area, see quality improvement organizations. Brailer, whose reputation included an appreciation of the merits of Free (Libre) and Open Source software (FLOSS) resigned from the post in April 2006.
The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U.S. Department of Health and Human Services to develop a set of standards for electronic health records (EHR) and supporting networks, and certify vendors who meet them. In July 2006, CCHIT released its first list of 22 certified ambulatory EHR products, in two different announcements.
European health informaticsThe European Union's Member States are committed to sharing their best practices and experiences to create a European eHealth Area, thereby improving access to and quality of healthcare at the same time as stimulating growth in a promising new industrial sector. The European eHealth Action Plan plays a fundamental role in the European Union's strategy. Work on this initiative involves a collaborative approach among several parts of the Commission services.
In the United Kingdom, moves towards registration and regulation of those involved in Health Informatics have begun with the formation of the UK Council for Health Informatics Professions (UKCHIP).[7]
The NHS in England has also contracted out to several vendors for a National Medical Informatics system 'NPFIT' that divides the country into five regions and is to be united by a central electronic medical record system nicknamed "the spine" [8]. The project, in 2006, is well behind schedule and its scope and design are being revised in real time.
In 2006, 60% of residents in England and Wales have more or less extensive clinical records and their prescriptions generated on 4000 installations of one system (EMIS) written in 'M' (MUMPS as was). The other 40% predominantly have records stored on assorted SQL or file-based systems.
Scotland has a similar approach to central connection under way which is more advanced than the English one in some ways.
Scotland has the GPASS system whose source code is owned by the State, and controlled and developed by NHS Scotland. It has been provided free to all GPs in Scotland but has developed poorly. Discussion of open sourcing it as a remedy is occurring.
The European Commission's preference, as exemplified in the 5th Framework, is for Free/Libre and Open Source Software (FLOSS) for healthcare.
Clinical Informatics in AsiaIn Asia and Australia-New Zealand, the regional group called the Asia Pacific Association for Medical Informatics (APAMI) was established in 1994 and now consists of more than 15 member regions in the Asia Pacific Region.[10]
In Hong Kong a computerized patient record system called the Clinical Management System (CMS) has been developed by the Hospital Authority since 1994. This system has been deployed at all the sites of the Authority (40 hospitals and 120 clinics), and is used by all 30,000 clinical staff on a daily basis, with a daily transaction of up to 2 millions. The comprehensive records of 7 million patients are available on-line in the Electronic Patient Record (ePR), with data integrated from all sites. Since 2004 radiology image viewing has been added to the ePR, with radiography images from any HA site being available as part of the ePR.
The Hong Kong Hospital Authority placed particular attention to the governance of clinical systems development, with input from hundreds of clinicians being incorporated through a structured process. The Health Informatics Section in Hong Kong Hospital Authority[11] has close relationship with Information Technology Department and clinicians to develop healthcare systems for the organization to support the service to all public hospitals and clinics in the region.
The Hong Kong Society of Medical Informatics (HKSMI) was established in 1987 to promote the use of information technology in healthcare.[12] Recently the eHealth Consortium has been formed to bring together clinicians from both the private and public sectors, medical informatics professionals and the IT industry to further promote IT in healthcare in Hong Kong.[13]
The Indian Association for Medical Informatics (IAMI) was established in 1993. IAMI has been publishing the Indian Journal of Medical Informatics since 2004.
Health informatics in Australia & OceaniaIn 2002 the Australian College of Health Informatics (ACHI) was formed as a professional association and peak health informatics professional body. It represents the interests of a broad range of clinical and non-clinical professionals working within the Health Informatics sphere through a commitment to quality, standards and ethical practice. ACHI works to enhance the national capacity in health informatics in research, education and training, policy and system implementation.[16]
Although there are a number of health informatics organisations in Australia, the Health Informatics Society of Australia Ltd (HISA) is regarded as the major umbrella group and is a member of the International Medical Informatics Association (IMIA).[17] Nursing informaticians were the driving force behind the formation of HISA, which is now a company limited by guarantee of the members. The membership comes from across the informatics spectrum that is from students to corporate affiliates. HISA has a number of branches (Queensland, New South Wales, Victoria and Western Australia) as well as special interest groups such as nursing (NIA), pathology, aged and community care, industry and medical imaging (Conrick, 2006).
-WIKIMEDIA
Subdomains of (bio)medical or health care informatics include: clinical informatics, nursing informatics, imaging informatics, consumer health informatics, public health informatics, dental informatics, clinical research informatics, bioinformatics, veterinary informatics, and pharmacy informatics.
A list of Health Informatics Publications is being developed at Health Informatics Publications.
ASPECTS OF MEDICAL INFORMATICS1. architectures for electronic medical records and other health information systems used for billing, scheduling or research 2. decision support systems in healthcare, including clinical decision support systems 3. standards (e.g. DICOM, HL7) and integration profiles (e.g. Integrating the Healthcare Enterprise) to facilitate the exchange of information between healthcare information systems - these specifically define the means to exchange data, not the content 4. controlled medical vocabularies (CMVs) such as the Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT), Logical Observation Identifiers Names and Codes (LOINC), OpenGALEN Common Reference Model or the highly complex UMLS - used to allow a standard, accurate exchange of data content between systems and providers 4. use of hand-held or portable devices to assist providers with data entry/retrieval or medical decision-making
HISTORYThere is a patent pending for a Medical Informatics Public Utility which would serve as the "common platform" of communication for all existing provincial software products as well as the safe repository for the public's medical records. The potential for the reduction of medical errors, fraud and reduction of duplication is staggering. The number of lives saved could exceed a minimum of 100,000 per year according to the Institute of Medicine's current medical error mortality statistics.
Medical informatics began to take off in the US in the 1950s with the rise of the microchip and computers.
Early names for medical informatics included medical computing, medical computer science, computer medicine, medical electronic data processing, medical automatic data processing, medical information processing, medical information science, medical software engineering and medical computer technology.
Since the 1970s the coordinating body has been the International Medical Informatics Association (IMIA)
MEDICAL HEALTH INFORMATICS LAW
Health informatics law deals with evolving and sometimes complex legal principles as they apply to information technology in health-related fields. It addresses the privacy, ethical and operational issues that invariably arise when electronic tools, information and media are used in health care delivery. Health Informatics Law also applies to all matters that involve information technology, health care and the interaction of information. It deals with the circumstances under which data and records are shared with other fields or areas that support and enhance patient care.
UTILITY OF MEDICAL INFORMATICS
Both political parties continue to squabble without solutions about the escalating costs of health care as benefits erode and more and more working Americans lose coverage. The problem with controlling health care costs is that the health care system itself is out of control because it lacks controls. Health information management is in a chaotic state of affairs as it is a collage of paper records, and medical practice software which do not record clinical encounters. Instead they capture charges. And electronic medical records software companies are incapable of communicating across their provincial software platforms. The solution to this grave problem is actually rather simple.
Public utilities have historically been established to protect the health, safety, and welfare of the public at large. Public utilities are funded by bond issues, deliver a return on investment, and are subject to public review and oversight. A Medical Informatics Public Utility, which would serve as the repository for the real time medical records of the public, would offer a quality and efficiency of care that can potentially free up 25% of the health care spending in the United States alone to meet the growing needs of the aging population. Many studies have concluded that a centralized repository of information can achieve these goals but have not offered a solution.
A Medical Informatics Public Utility would serve as the "common platform" of communication for all existing provincial software products as well as the safe repository for the public's medical records. The potential for the reduction of medical errors, fraud and reduction of duplication is staggering. The number of lives saved could exceed a minimum of 100,000 per year according to the Institute of Medicine's current medical error mortality statistics.
Most importantly, a Medical Informatics Public Utility would serve as a tremendous economic engine in that: the real time database developed would create a platform to get new treatments to market more quickly and more effectively evaluated, spot epidemiological events faster, induce software developers to develop products for the new total repository environment, free up funds to utilize more hands on care, allow for patient centered care and patient control of their health care, and allow physician to physician access of the patient's complete medical record.
UNITED STATES' MEDICAL INFORMATICSThe earliest use of computation for medicine was for dental projects in the 1950s at the United States National Bureau of Standards by Robert Ledley.
The next step in the mid 1950s were the development of expert systems such as MYCIN and INTERNIST-I. In 1965, the National Library of Medicine started to use MEDLINE and MEDLARS. At this time, Neil Pappalardo, Curtis Marble, and Robert Greenes developed MUMPS (Massachusetts General Hospital Utility Multi-Programming System) in Octo Barnett's Laboratory of Computer Science at Massachusetts General Hospital in Boston. In the 1970s and 1980s it was the most commonly used programming language for clinical applications. The MUMPS operating system was used to support MUMPS language specifications. As of 2004, a descendent of this system is being used in the United States Veterans Affairs hospital system.The VA has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture or VistA. A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 healthcare facilities.
In the 1970's a growing number of commercial vendors began to market practice management and electronic medical records systems. Although a profusion of products exists, currently only a minority of health practitioners use fully featured electronic healthcare records systems.
In the United States in 1996, HIPAA regulations concerning privacy and medical record transmission created the impetus for large numbers of physicians to move towards using EMR software, primarily for the purpose of secure medical billing.
In the US, progress towards a standardized health information infrastructure is underway. In 2004, the US Department of Health and Human Services (HHS) formed the Office of the National Coordinator for Health Information Technology (ONCHIT) [1], headed by David J. Brailer, M.D., Ph.D. The mission of this office is to achieve widespread adoption of interoperable electronic health records (EHRs) in the US within 10 years. For more information regarding federal initiatives in this area, see quality improvement organizations. Brailer, whose reputation included an appreciation of the merits of Free (Libre) and Open Source software (FLOSS) resigned from the post in April 2006.
The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U.S. Department of Health and Human Services to develop a set of standards for electronic health records (EHR) and supporting networks, and certify vendors who meet them. In July 2006, CCHIT released its first list of 22 certified ambulatory EHR products, in two different announcements.
European health informaticsThe European Union's Member States are committed to sharing their best practices and experiences to create a European eHealth Area, thereby improving access to and quality of healthcare at the same time as stimulating growth in a promising new industrial sector. The European eHealth Action Plan plays a fundamental role in the European Union's strategy. Work on this initiative involves a collaborative approach among several parts of the Commission services.
In the United Kingdom, moves towards registration and regulation of those involved in Health Informatics have begun with the formation of the UK Council for Health Informatics Professions (UKCHIP).[7]
The NHS in England has also contracted out to several vendors for a National Medical Informatics system 'NPFIT' that divides the country into five regions and is to be united by a central electronic medical record system nicknamed "the spine" [8]. The project, in 2006, is well behind schedule and its scope and design are being revised in real time.
In 2006, 60% of residents in England and Wales have more or less extensive clinical records and their prescriptions generated on 4000 installations of one system (EMIS) written in 'M' (MUMPS as was). The other 40% predominantly have records stored on assorted SQL or file-based systems.
Scotland has a similar approach to central connection under way which is more advanced than the English one in some ways.
Scotland has the GPASS system whose source code is owned by the State, and controlled and developed by NHS Scotland. It has been provided free to all GPs in Scotland but has developed poorly. Discussion of open sourcing it as a remedy is occurring.
The European Commission's preference, as exemplified in the 5th Framework, is for Free/Libre and Open Source Software (FLOSS) for healthcare.
Clinical Informatics in AsiaIn Asia and Australia-New Zealand, the regional group called the Asia Pacific Association for Medical Informatics (APAMI) was established in 1994 and now consists of more than 15 member regions in the Asia Pacific Region.[10]
In Hong Kong a computerized patient record system called the Clinical Management System (CMS) has been developed by the Hospital Authority since 1994. This system has been deployed at all the sites of the Authority (40 hospitals and 120 clinics), and is used by all 30,000 clinical staff on a daily basis, with a daily transaction of up to 2 millions. The comprehensive records of 7 million patients are available on-line in the Electronic Patient Record (ePR), with data integrated from all sites. Since 2004 radiology image viewing has been added to the ePR, with radiography images from any HA site being available as part of the ePR.
The Hong Kong Hospital Authority placed particular attention to the governance of clinical systems development, with input from hundreds of clinicians being incorporated through a structured process. The Health Informatics Section in Hong Kong Hospital Authority[11] has close relationship with Information Technology Department and clinicians to develop healthcare systems for the organization to support the service to all public hospitals and clinics in the region.
The Hong Kong Society of Medical Informatics (HKSMI) was established in 1987 to promote the use of information technology in healthcare.[12] Recently the eHealth Consortium has been formed to bring together clinicians from both the private and public sectors, medical informatics professionals and the IT industry to further promote IT in healthcare in Hong Kong.[13]
The Indian Association for Medical Informatics (IAMI) was established in 1993. IAMI has been publishing the Indian Journal of Medical Informatics since 2004.
Health informatics in Australia & OceaniaIn 2002 the Australian College of Health Informatics (ACHI) was formed as a professional association and peak health informatics professional body. It represents the interests of a broad range of clinical and non-clinical professionals working within the Health Informatics sphere through a commitment to quality, standards and ethical practice. ACHI works to enhance the national capacity in health informatics in research, education and training, policy and system implementation.[16]
Although there are a number of health informatics organisations in Australia, the Health Informatics Society of Australia Ltd (HISA) is regarded as the major umbrella group and is a member of the International Medical Informatics Association (IMIA).[17] Nursing informaticians were the driving force behind the formation of HISA, which is now a company limited by guarantee of the members. The membership comes from across the informatics spectrum that is from students to corporate affiliates. HISA has a number of branches (Queensland, New South Wales, Victoria and Western Australia) as well as special interest groups such as nursing (NIA), pathology, aged and community care, industry and medical imaging (Conrick, 2006).
-WIKIMEDIA
Global Healthcare Systems
A health care system is the organization and the method by which health care is provided. In practice, these systems vary widely from one country to another, and not all health care is delivered by way of a health care system. Comparing systems is the focus of health care politics and current research, but generally systems are compared by how they are financed and how they are managed.
GOALS: The goals for health systems, according to the World Health Report (WHO, 2000), are good health, responsiveness to the expectations of the population, and fair financial contribution. Duckett (2004) proposed a two dimensional approach to evaluation of health care systems: quality, efficiency and acceptability on one dimension and equity on another.
FINANCING: generally five primary methods of funding health care systems:direct or out-of-pocket payments, general taxation, social health insurance, voluntary or private health insurance, and donations or community health insurance. Although some view health care from an economic perspective as being no different from other products or services, others believe it has many characteristics that encourage government intervention or regulation:
The provision of critical health care treatment is often regarded as a basic human right, regardless of whether the individual has the means to pay—some treatments cost more than a typical family's life savings. Health care professionals are bound by law and their oaths of service to provide lifesaving treatment. People often lack the information or understanding to be able to choose rationally between competing health care providers when they need treatment, particularly in the event of the need of urgent or emergency treatment.
STATE HEALTHCARE MODELS/STRUCTURE: Purely private enterprise health care systems are comparatively rare. Where they exist, it is usually for a comparatively well-off subpopulation in a poorer country with a poorer standard of health care–for instance, private clinics for a small, wealthy expatriate population in an otherwise poor country. But there are countries with a majority-private health care system with residual public service (see Medicare, Medicaid). The other major models are public insurance systems: Social security health care model, where workers and their families are insured by the State. Publicly funded health care model, where the residents of the country are insured by the State. Social health insurance, where the whole population or most of the population is a member of a sickness insurance company. In almost every country with a government health care system a parallel private system is allowed to operate. This is sometimes referred to as two-tier health care. The scale, extent, and funding of these private systems is very variable.
For the application of health care systems in schools see school health services.
COUNTRY BY COUNTRY EXAMPLES:In Australia the current system, known as Medicare, was instituted in 1984. It coexists with a private health system. Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that heavily subsidises prescription medications. Canada has a federally sponsored, publicly funded Medicare system, with most services provided by the private sector. Each province may opt out, though none currently do. Canada's system is known as a single payer system, where basic services are provided by private doctors, (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate. Most all family doctors receive a fee per visit. These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. A physician cannot charge a fee for a service that is higher than the negotiated rate - even to patients who are not covered by the publicly funded system - unless he opts out of billing the publicly funded system altogether. Pharmaceutical costs are set at a global median by government price controls. Other areas of health care, such as dentistry and optometry, are wholly private. Cuba has a government-coordinated system that guarantees universal coverage and consumes a lower proportion of the nation's GDP (7.3%) than some highly privatised systems (e.g. USA: 15.2%) (UNDP 2006: Table 6). The system does charge fees in treating elective treatment for patients from abroad, but tourists who fall ill are treated freely in Cuban hospitals. Cuba attracts patients mostly from Latin America and Europe by offering care of comparable quality to a developed nation but at much lower prices. Cuba's own health indicators are the best in Latin America and surpass those of the US in some respects (infant mortality rates, underweight babies, HIV infection, immunisation rates, doctor per population rates). (UNDP 2006: Tables 6,7,9,10) In Finland, public medical services at clinics and hospitals are run by the municipalities (local government) and are funded 76% by taxation, 20% by patients through access charges, and by others 4%. Patient access charges are subject to annual caps. For example GP visits are (11€ per visit with annual 33€ cap), hospital outpatient treatment (22€ per visit), a hospital stay, including food, medical care and medicines (26€ per 24 hours, or 12€ if in a psychiatric hospital). After a patient has spent 590€ per year on public medical services, all treatment and medications thereafter are free. Taxation funding is partly local and partly nationally based. Patients can claim re-imbursement of part of their prescription costs from KELA. Finland also has a much smaller private medical sector which accounts for about 14 percent ot total health care spending. Only 8% of doctors choose to work in private practice, and some of these also choose to do some work in the public sector. Private sector patients can claim a contribution from KELA towards their private medical costs (including dentistry) if they choose to be treated in the more expensive private sector, or they can join private insurance funds. In France, most doctors remain in private practice; there are both private and public hospitals. Social Security consists of several public organizations, distinct from the state government, with separate budgets that refunds patients for care in both private and public facilities. It generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers. Until recently, social security coverage was restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments of the population; the government of Lionel Jospin put into place the "universal health coverage". In some systems, patients can also take private health insurance, but choose to receive care at public hospitals, if allowed by the private insurer. Germany has a universal multi-payer system with two main types of health insurance: "Compulsory health insurance" (Gesetzlich) and "Private" (Privat).[3][4][5] In Ghana, most health care is provided by the government, but hospitals and clinics run by religious groups also play an important role. Some for profit clinics exist, but they provide less than 2% of health services. Health care is very variable through the country. The major urban centres are well served, but rural areas often have no modern health care. Patients in these areas either rely on traditional medicine or travel great distances for care. In Hong Kong, both private and public clinics are common, while public hospitals account for the majority of the market. In India, the hospitals are run by government, charitable trusts and by private organizations. The government hospitals in rural areas are called the primary health centre(PHC)s. Major hospitals are located in district head quarters or major cities. Apart from the modern system of medicine, traditional and indigenous medicinal systems like Ayurvedic and Unani systems are in practice throughout the country. In Israel, the publicly funded medical system is universal and compulsory. Payment for the services are shared by labor unions and the government. In Italy the public system has the unique feature of paying its doctors a fee per capita per year, a salary system, that does not reward repeat visits, testing, and referrals. [6] Italy, has one of the highest doctor per capita ratio's at 3.9 doctors per 1,000 patients respectively. [7] In Japan, services are provided either through regional/national public hospitals or through private hospitals/clinics, and patients have universal access to any facility, though hospitals tend to charge higher for those without referral. Public health insurance covers most citizens/residents and pays 70% or more cost for each care and each prescribed drug. Patients are responsible for the rest of 30% (upper limits apply). Insurance system is funded by tax(40%), insurance premium from each household (35%) and from employer (25%). Monthly insurance fee is 0-50,000 JPY per household (scaled to annual income). Supplementary private health insurance is available only to cover the copayments or non-covered cost, and usually makes fixed payment per days in hospital or per surgery performed, rather than per actual expenditure. In the Netherlands, a system of standardised and mandatory health insurance is in place, meant to encourage competition between healthcare providers and insurers. The insurance policies are paid for through a system of levies and subsidies as well as a premium paid by the insured, from which children under 18 are exempt. In New Zealand hospitals are public and treat citizens or permanent residents free of charge and are managed by District Health Boards. Under the current Labour coalition governments, 1999 - present, there are plans to make primary health care available free of charge. At present government subsidies exist in health care. This system is funded by taxes. The New Zealand government agency PHARMAC subsides certain pharmaceuticals depending upon their category. Co-payments exist however these are ignored if the user has a community health services card or high user health card. In South Africa, parallel private and public systems exist. The public system serves the vast majority of the population, but is chronically underfunded and understaffed. The wealthiest 20% of the population uses the private system and are far better served. In Sweden, the publicly funded medical system is comprehensive and compulsory. Physician and hospital services take a small patient fee, but their services are funded through the taxation scheme of the County Councils of Sweden. In the United Kingdom there are three separate but co-operating National Health Services of Scotland, Northern Ireland and England and Wales. They provide free physician and hospital services to all permanent residents of the United Kingdom. Hospital staff are salaried employees according to nationally agreed contracts, whilst primary care is largely provided by independent practices, who are paid, again via a nationally agreed contract, according to the number of patients registered with them and the range of additional services offered. Around 86% of prescriptions are provided free. Prescriptions are provided free to people who satisfy certain criteria such as low income or permanent disabilities. People that pay for prescriptions do not pay the full cost. For example, in 2007, most people will pay a flat fee of £6.85 (€10.16, US$13.76) for a single drug prescription regardless of the cost (average cost to the health service was £11.10--about €16.70, US$20.40--in 2002). (Charges are lower in Wales, and the administration there is committed to their eventual elimination.) Funding comes from general taxation. Private health services are also available. Private health care continues parallel to the NHS, paid for largely by private insurance, but it is used only by a small percentage of the population, and generally as a supplement to NHS services. The United States is alone among developed nations with the absence of a universal healthcare system. Healthcare in the U.S. does, however, have significant publicly funded components. Medicare covers the elderly and disabled with a historical work record, Medicaid is available for the poor, and the State Children's Health Insurance Program covers children of low-income families. The Veterans Health Administration directly provides health care to U.S. military veterans through a nationwide network of government hospitals. Eligibility is determined by Priority Groups. Retirees and those with service-connected injuries are within the higher priority groups, while non-injured veterans may become eligible based on financial need (reference eligibility Priority Groups).[8] Current servicemen and women are provided care at military facilities while on active duty. Reservists also have access to care while on active duty. Family members of full-time active duty personnel are covered under CHAMPUS (Civilian Health and Medical Program of the Uniformed Services). Together, these tax-financed programs cover about 27% of the population[9] and make the government the largest health insurer in the nation. In 2001, only the governments of Iceland and Norway spent more per capita on healthcare.[10] This care is generally provided by privately owned hospitals or physicians in private practice, but public hospitals are common in older cities. Just under 60% of Americans receive health insurance through an employer, although this number is declining and the employee's expected contribution to these plans varies widely and is increasing as costs escalate. A significant and growing number of people cannot obtain health insurance through their employer or are unable to afford individual coverage. Currently, the U.S. Census Bureau estimates that 16% of the U.S. population, or 47 million people, are uninsured. More than a third of the uninsured are in households earning $50,000 or more per year.[9] Some uninsured are people under age 30 who don't believe they need to purchase health care; others are eligible for Medicaid but have not applied. The cost of medicines is frequently not covered by insurance, and it is common for U.S. citizens to travel to Canada and Mexico for drug purchases at prices far below those in their home areas. A few states have taken serious steps toward universal health care coverage, most notably Minnesota and Massachusetts, with a recent example being the Massachusetts 2006 Health Reform Statute.[11] Other states, while not attempting to insure all of their residents, cover large numbers of people by reimbursing hospitals and other health-care providers using what is generally characterized as a charity care scheme; New Jersey is perhaps the best example of a state that employs the latter strategy. It is typical for most forms of general liability insurance sold in the U.S., such as home, automobile, or business insurance to have a significant premium allocation for medical damages. The U. S. legal system, which has the highest number of attorneys per capita of any country in the world, is available to assist in proving liability and collecting the money for medical bills from such insurances. The Indian Health Service provides public funded care for indigenous peoples. Employer benefit based health insurance remains quite common with larger employers. Workers injured on the job are covered by government mandated worker compensation insurance and wage replacement benefits. These benefits vary considerably state-to-state and employers bear the cost of this insurance. Businesses with considerable risks, such as bridge-building, mining, or meat processing face far higher worker compensation insurance costs than do office based clerical businesses.Although the Medical colleges and research institutes form a backbone structure for providing healthcare, the private hospitals and nursing homes also are becoming an increasingly necessary part of the healthcare structure in the country.
(Contributed) WIKIMEDAI - UNITED STATES
GOALS: The goals for health systems, according to the World Health Report (WHO, 2000), are good health, responsiveness to the expectations of the population, and fair financial contribution. Duckett (2004) proposed a two dimensional approach to evaluation of health care systems: quality, efficiency and acceptability on one dimension and equity on another.
FINANCING: generally five primary methods of funding health care systems:direct or out-of-pocket payments, general taxation, social health insurance, voluntary or private health insurance, and donations or community health insurance. Although some view health care from an economic perspective as being no different from other products or services, others believe it has many characteristics that encourage government intervention or regulation:
The provision of critical health care treatment is often regarded as a basic human right, regardless of whether the individual has the means to pay—some treatments cost more than a typical family's life savings. Health care professionals are bound by law and their oaths of service to provide lifesaving treatment. People often lack the information or understanding to be able to choose rationally between competing health care providers when they need treatment, particularly in the event of the need of urgent or emergency treatment.
STATE HEALTHCARE MODELS/STRUCTURE: Purely private enterprise health care systems are comparatively rare. Where they exist, it is usually for a comparatively well-off subpopulation in a poorer country with a poorer standard of health care–for instance, private clinics for a small, wealthy expatriate population in an otherwise poor country. But there are countries with a majority-private health care system with residual public service (see Medicare, Medicaid). The other major models are public insurance systems: Social security health care model, where workers and their families are insured by the State. Publicly funded health care model, where the residents of the country are insured by the State. Social health insurance, where the whole population or most of the population is a member of a sickness insurance company. In almost every country with a government health care system a parallel private system is allowed to operate. This is sometimes referred to as two-tier health care. The scale, extent, and funding of these private systems is very variable.
For the application of health care systems in schools see school health services.
COUNTRY BY COUNTRY EXAMPLES:In Australia the current system, known as Medicare, was instituted in 1984. It coexists with a private health system. Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that heavily subsidises prescription medications. Canada has a federally sponsored, publicly funded Medicare system, with most services provided by the private sector. Each province may opt out, though none currently do. Canada's system is known as a single payer system, where basic services are provided by private doctors, (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate. Most all family doctors receive a fee per visit. These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. A physician cannot charge a fee for a service that is higher than the negotiated rate - even to patients who are not covered by the publicly funded system - unless he opts out of billing the publicly funded system altogether. Pharmaceutical costs are set at a global median by government price controls. Other areas of health care, such as dentistry and optometry, are wholly private. Cuba has a government-coordinated system that guarantees universal coverage and consumes a lower proportion of the nation's GDP (7.3%) than some highly privatised systems (e.g. USA: 15.2%) (UNDP 2006: Table 6). The system does charge fees in treating elective treatment for patients from abroad, but tourists who fall ill are treated freely in Cuban hospitals. Cuba attracts patients mostly from Latin America and Europe by offering care of comparable quality to a developed nation but at much lower prices. Cuba's own health indicators are the best in Latin America and surpass those of the US in some respects (infant mortality rates, underweight babies, HIV infection, immunisation rates, doctor per population rates). (UNDP 2006: Tables 6,7,9,10) In Finland, public medical services at clinics and hospitals are run by the municipalities (local government) and are funded 76% by taxation, 20% by patients through access charges, and by others 4%. Patient access charges are subject to annual caps. For example GP visits are (11€ per visit with annual 33€ cap), hospital outpatient treatment (22€ per visit), a hospital stay, including food, medical care and medicines (26€ per 24 hours, or 12€ if in a psychiatric hospital). After a patient has spent 590€ per year on public medical services, all treatment and medications thereafter are free. Taxation funding is partly local and partly nationally based. Patients can claim re-imbursement of part of their prescription costs from KELA. Finland also has a much smaller private medical sector which accounts for about 14 percent ot total health care spending. Only 8% of doctors choose to work in private practice, and some of these also choose to do some work in the public sector. Private sector patients can claim a contribution from KELA towards their private medical costs (including dentistry) if they choose to be treated in the more expensive private sector, or they can join private insurance funds. In France, most doctors remain in private practice; there are both private and public hospitals. Social Security consists of several public organizations, distinct from the state government, with separate budgets that refunds patients for care in both private and public facilities. It generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers. Until recently, social security coverage was restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments of the population; the government of Lionel Jospin put into place the "universal health coverage". In some systems, patients can also take private health insurance, but choose to receive care at public hospitals, if allowed by the private insurer. Germany has a universal multi-payer system with two main types of health insurance: "Compulsory health insurance" (Gesetzlich) and "Private" (Privat).[3][4][5] In Ghana, most health care is provided by the government, but hospitals and clinics run by religious groups also play an important role. Some for profit clinics exist, but they provide less than 2% of health services. Health care is very variable through the country. The major urban centres are well served, but rural areas often have no modern health care. Patients in these areas either rely on traditional medicine or travel great distances for care. In Hong Kong, both private and public clinics are common, while public hospitals account for the majority of the market. In India, the hospitals are run by government, charitable trusts and by private organizations. The government hospitals in rural areas are called the primary health centre(PHC)s. Major hospitals are located in district head quarters or major cities. Apart from the modern system of medicine, traditional and indigenous medicinal systems like Ayurvedic and Unani systems are in practice throughout the country. In Israel, the publicly funded medical system is universal and compulsory. Payment for the services are shared by labor unions and the government. In Italy the public system has the unique feature of paying its doctors a fee per capita per year, a salary system, that does not reward repeat visits, testing, and referrals. [6] Italy, has one of the highest doctor per capita ratio's at 3.9 doctors per 1,000 patients respectively. [7] In Japan, services are provided either through regional/national public hospitals or through private hospitals/clinics, and patients have universal access to any facility, though hospitals tend to charge higher for those without referral. Public health insurance covers most citizens/residents and pays 70% or more cost for each care and each prescribed drug. Patients are responsible for the rest of 30% (upper limits apply). Insurance system is funded by tax(40%), insurance premium from each household (35%) and from employer (25%). Monthly insurance fee is 0-50,000 JPY per household (scaled to annual income). Supplementary private health insurance is available only to cover the copayments or non-covered cost, and usually makes fixed payment per days in hospital or per surgery performed, rather than per actual expenditure. In the Netherlands, a system of standardised and mandatory health insurance is in place, meant to encourage competition between healthcare providers and insurers. The insurance policies are paid for through a system of levies and subsidies as well as a premium paid by the insured, from which children under 18 are exempt. In New Zealand hospitals are public and treat citizens or permanent residents free of charge and are managed by District Health Boards. Under the current Labour coalition governments, 1999 - present, there are plans to make primary health care available free of charge. At present government subsidies exist in health care. This system is funded by taxes. The New Zealand government agency PHARMAC subsides certain pharmaceuticals depending upon their category. Co-payments exist however these are ignored if the user has a community health services card or high user health card. In South Africa, parallel private and public systems exist. The public system serves the vast majority of the population, but is chronically underfunded and understaffed. The wealthiest 20% of the population uses the private system and are far better served. In Sweden, the publicly funded medical system is comprehensive and compulsory. Physician and hospital services take a small patient fee, but their services are funded through the taxation scheme of the County Councils of Sweden. In the United Kingdom there are three separate but co-operating National Health Services of Scotland, Northern Ireland and England and Wales. They provide free physician and hospital services to all permanent residents of the United Kingdom. Hospital staff are salaried employees according to nationally agreed contracts, whilst primary care is largely provided by independent practices, who are paid, again via a nationally agreed contract, according to the number of patients registered with them and the range of additional services offered. Around 86% of prescriptions are provided free. Prescriptions are provided free to people who satisfy certain criteria such as low income or permanent disabilities. People that pay for prescriptions do not pay the full cost. For example, in 2007, most people will pay a flat fee of £6.85 (€10.16, US$13.76) for a single drug prescription regardless of the cost (average cost to the health service was £11.10--about €16.70, US$20.40--in 2002). (Charges are lower in Wales, and the administration there is committed to their eventual elimination.) Funding comes from general taxation. Private health services are also available. Private health care continues parallel to the NHS, paid for largely by private insurance, but it is used only by a small percentage of the population, and generally as a supplement to NHS services. The United States is alone among developed nations with the absence of a universal healthcare system. Healthcare in the U.S. does, however, have significant publicly funded components. Medicare covers the elderly and disabled with a historical work record, Medicaid is available for the poor, and the State Children's Health Insurance Program covers children of low-income families. The Veterans Health Administration directly provides health care to U.S. military veterans through a nationwide network of government hospitals. Eligibility is determined by Priority Groups. Retirees and those with service-connected injuries are within the higher priority groups, while non-injured veterans may become eligible based on financial need (reference eligibility Priority Groups).[8] Current servicemen and women are provided care at military facilities while on active duty. Reservists also have access to care while on active duty. Family members of full-time active duty personnel are covered under CHAMPUS (Civilian Health and Medical Program of the Uniformed Services). Together, these tax-financed programs cover about 27% of the population[9] and make the government the largest health insurer in the nation. In 2001, only the governments of Iceland and Norway spent more per capita on healthcare.[10] This care is generally provided by privately owned hospitals or physicians in private practice, but public hospitals are common in older cities. Just under 60% of Americans receive health insurance through an employer, although this number is declining and the employee's expected contribution to these plans varies widely and is increasing as costs escalate. A significant and growing number of people cannot obtain health insurance through their employer or are unable to afford individual coverage. Currently, the U.S. Census Bureau estimates that 16% of the U.S. population, or 47 million people, are uninsured. More than a third of the uninsured are in households earning $50,000 or more per year.[9] Some uninsured are people under age 30 who don't believe they need to purchase health care; others are eligible for Medicaid but have not applied. The cost of medicines is frequently not covered by insurance, and it is common for U.S. citizens to travel to Canada and Mexico for drug purchases at prices far below those in their home areas. A few states have taken serious steps toward universal health care coverage, most notably Minnesota and Massachusetts, with a recent example being the Massachusetts 2006 Health Reform Statute.[11] Other states, while not attempting to insure all of their residents, cover large numbers of people by reimbursing hospitals and other health-care providers using what is generally characterized as a charity care scheme; New Jersey is perhaps the best example of a state that employs the latter strategy. It is typical for most forms of general liability insurance sold in the U.S., such as home, automobile, or business insurance to have a significant premium allocation for medical damages. The U. S. legal system, which has the highest number of attorneys per capita of any country in the world, is available to assist in proving liability and collecting the money for medical bills from such insurances. The Indian Health Service provides public funded care for indigenous peoples. Employer benefit based health insurance remains quite common with larger employers. Workers injured on the job are covered by government mandated worker compensation insurance and wage replacement benefits. These benefits vary considerably state-to-state and employers bear the cost of this insurance. Businesses with considerable risks, such as bridge-building, mining, or meat processing face far higher worker compensation insurance costs than do office based clerical businesses.Although the Medical colleges and research institutes form a backbone structure for providing healthcare, the private hospitals and nursing homes also are becoming an increasingly necessary part of the healthcare structure in the country.
(Contributed) WIKIMEDAI - UNITED STATES
Subscribe to:
Posts (Atom)
